Self reported poor health and low educational level predictors for mortality: A population based follow up study of 39156 people in Sweden

Objective - To analyse the relative risk (RR) of mortality for people who reported poor health or had low educational level. Setting - Sweden. Design - A random sample of 39 156 people was interviewed face to face by Statistics Sweden from 1979-85. The dependent variable was total mortality. Independent variables were sex, age, marital status, and socioeconomic position, defined as educational level, type of housing tenure, and health status. This study was designed as a follow up study ranging from 1 January 1979 to 31 December 1993. Information on the dependent variables was obtained from the central cause of death register. Respondents were linked to the register by the Swedish personal registration number. Person-years at risk were calculated from the date of the interview until death, or for those who survived, until the end of the follow up period. Data were analysed in relation to gender and age (25-59 years and 60-74 years) in a proportional hazard model in order to estimate RR. Results - During follow up 2656 men and 1706 women died. Men and women in both age groups who reported poor health status at the interview had a strongly increased risk of dying during the follow up period (RR=2.05 (95% confidence interval 1.72, 2.31) and RR=1.91 (1.74,2.10) for men, and RR=2.34 (1.94,2.83) and RR=1.80 (1.61,2.02) for women for the younger and older age groups respectively) when simultaneously controlled for age, marital status, education, and housing tenure. Living alone, renting an apartment, and low educational level (less than or equal to 9 years) were also associated with increased mortality risks for men and women in both age groups. Conclusion - Poor self reported health was a strong predictor for total mortality. Furthermore, in Sweden, a country well known for the equality of its income distribution, there are inequalities in health with higher total mortality risks for people with a low educational level and those who are not owner-occupiers.